The more you need help the less willing people are to provide it + the intersection of work and treatment

A few weeks ago I decided to give CBT another shot. How is it fair for me to fully reject it as a treatment option for myself, when my experience with it has been so poorly applied?
I picked out a local prestigious research center and gave them a call.

I felt that maybe the failures with my previous efforts to get “real CBT” were because I was looking for treatment in the community rather than from researchers. Maybe this “empirically supported treatment” only exists in the magical world of academia. The treatment outside might share the same name, but maybe it is something different.

In the past I’ve avoided treatment research studies (even though I’ve participated in many other types of studies) because I worried about the guilt I’d feel when I didn’t get better. I don’t want to ruin their study.

I don’t talk about my work here much, both to maintain my anonymity and due to confidentiality rules. I love what I am doing and I am making amazing professional connections. It is doing wonderful things for my developing career, but not so good things for my ability to find treatment. I am very concerned about keeping my crazy separate from my professional life. Most of the people I work with are therapists.
As my therapist list grows longer and longer and my work social network also expands I’m running into increasing problems of overlap between the two. I know that both therapists number 23 and 25 in particular had some form of connection to people whom I work with. I’m sure others have had connections I don’t know about.

S.M has tried to assure me that some amount of this problem is very typical for folks working in the mental health field and that clinicians should be able to handle it tactfully. The problem is that most people only have one therapist they are awkwardly avoiding in their professional life. I have 25 and counting.
If I knew for sure, ‘ok this therapist is the last one I will ever have to see, because this therapist will be a good fit’ then I might be less concerned about the therapist possibly knowing a coworker or attending some of the same conferences as me. The problem is that in all likelihood therapist number 26 won’t be able to help me any more than the other 24 (S.M is excluded as I only left him because he’s located far away). As I see more and more therapists I cut off more and more career options. I wish I could wipe my identifying bits of information out of a therapists head after I fire them.
The ideal therapist for me would be completely professionally isolated, the problem is that someone that isolated is not likely a very good clinician.

It may seem like I got a bit off topic in the above paragraph from my thesis sentence, but here’s where it connects. Something that made this Prestigious Research Center (henceforth known as PRC because psychologists love acronyms almost as much as Unitarian Universalists) a wonderful choice for my treatment is that I have zero desire to work there. We have differing theoretical interests and this is a place that would be particularly hostile for a person with my perspective to work. I could go there as a patient and not feel like I am blocking off a future job opprotunity.

I played telephone tag for a week with PRC and finally got in touch with a fellow who conducted a phone screening interview. I prefaced the interview by letting him know that I realize I’m not the ideal person for their research, due to my large amount of treatment experience and number of co-morbid diagnoses. He said this was fine, because the research clinicians also see patients there outside of the studies.
I thought this was great. I could get the research clinician without the guilt of sabotaging their study.
He said that sometimes they do have to refer people out with certain kinds of problems that they don’t work with e.g. substance abuse. As substance abuse is not a problem of mine, I wasn’t concerned.

I became even more attached to PRC when he told me that all of their patients go through a thorough assessment prior to therapy (things like personality measures, structured clinical interview etc) with an accompanying report.
I have a large stack of neuropsychological testing, but never any formal assessment, independent of the treatment, about the rest of my crazy. If nothing else I was excited about the idea of a beautiful organized report with charts and standard deviations. I adore data. Even if this therapy didn’t work out at least I’d have a report (albeit one biased towards militant CBT research) to show future clinicians.

The phone interview lasted an hour and a half. I was told I’d get a call back from the main desk to book an appointment for the assessment. Instead the fellow from the phone interview called me back to say they were unable to work with me. He’d talked to his supervisor who told him they had a policy of not working with anyone who has had more than 2 hospitalizations in the past 5 years (I’ve had 3). Then he offered me a referral to Other Prestigious Research Center.
The problem? Other Prestigious Research Center is where I work. Not in the specific part he referred me to, but very closely affiliated with it. This isn’t just a matter of me being obsessed with boundaries where I avoid people even loosely associated with my work. This is closely related enough that it would be unbelievably inappropriate for me to look for treatment at this particular location.
I was so taken by surprise that I actually told him why I couldn’t use that referral. An unusual self-revelation for me.
He got back to me the next day with more referrals except this time for people in private practice. When I googled them it turns out they both worked at the same Other Prestigious Research Center that I have to avoid.

So my plan of getting CBT was foiled again. I called S.M. asking for a referral. I feel so awful coming back to him over and over. He has a hard time making these referrals because he doesn’t know many people in my area.

For the past couple of years he’s been trying to get me to see a “senior analyst” for a consultation. Someone too busy (or mostly retired) to take on any new patients, but who could be a fresh set of eyes for my problems and would know clinicians in my area well enough to select a strong match.
I’d been turning him down, because I didn’t want to add an extra person who knows my problems to the world unless they were someone I was planning to meet with long term. I finally agreed to give this a shot.
He told me a name and I googled her to establish sufficient separation from work. She is loosely connected but far enough apart that I can tolerate it. S.M told me he would give her a call and see if she could see me for a consultation.

It been a couple of weeks. I’m not sure what’s going on. I guess she’s not answering his call? S.M. keeps telling me he expects to hear back soon, but it hasn’t happened.
Meanwhile I’m waiting, feeling like I can’t try to pursue other options (as if I even have any) until this sorts itself out.
I’ll go to work next week where I’m surrounded by therapists, while I am still unable to find a therapist for myself.

CBT therapist

I’m not going to apologize for my lack of posting, because I hate reading those.

After firing therapist number 23, I thought I might take a break from therapy for a bit. I was very angry at him, but leaving was a huge relief and immediately had a positive impact on my mood. The relief lasted a bit, but soon, without another outlet, some grumpyness began to ooze into my professional life.

I really like psychodynamic theories. The therapist who I have liked the most was psychodynamically oriented, while the one who kicked me out of school was into CBT.

I keep seeking out these psychodynamic therapists in an effort to replicate the therapy I had with this other therapist (S.M.). I want this idealized perfect therapy that I read about in text books. I want one where there are insightful interpretations and the new relationship disproves the assumptions from my old object relations.

My best and worst ideas are impulses that come to me while trying to sleep or taking a shower. I lept out of bed to the computer. I needed something completely different.
I searched on the ABCT therapist directory. I would find a CBT therapist.
This was harder than I expected.
Despite living in an area with a relatively high population of therapists, the list was short. Many of the names were names of researchers working at one particular research center. I didn’t want to participate in a study. I’d feel too guilty when I didn’t get better.
I narrowed the list to two choices and went to sleep.

I made a call to one therapist in the morning.

After the call I began rationalizing my impulsive, poorly thought out decision.

“This isn’t real therapy”, I thought. “This is rebound therapy”.
I don’t believe CBT has the ability to ultimately fix my problems, but I thought maybe I should give it another shot
temporarily. After all it is really the B part, behavioral, I object to, the C part, Cognitive, is not so bad. If I could find a person using the right balance of minimal B and mostly C, maybe it could work.

I figured it could be short term and might shove me out of my therapy rut.

Whenever I disagreed with my previous therapist’s interpretations he would argue that maybe the process he was speaking of was unconscious. It was infuriating, when he would pull things out of seemingly nowhere and say this. How can you argue with the unconscious?
At least with CBT I could dodge that.

I made an appointment and began to feel guilty.

I have so much anger towards the CBT therapist who got me kicked out of my school much of which has generalized to the theoretical perspective as a whole. This poor woman would have to be subjected to this. She had no way of knowing what she was getting into. She’d done nothing wrong yet, I’d not even met her, but I was feeling intense rage and fear towards her.

I felt awful about what I would put this poor woman through and decided I needed a peace-offering to begin with.

Where do CBT and I have common ground? We both like data. I keep track of a number of variables in my life.
I decided to print out an excel sheet of the past several months of certain variables, complete with averages at the bottom of each column.
As it turned out, I never showed her the spreadsheet, because the timing was never right.

I built her up in my head as this monster I needed to defend myself against. When I arrived at the first appointment to discover she had only one head and no visible fangs it was a relief. Almost anything she could have done would have been better than my expectations.

Much of the anger dissipated once I entered the waiting room for the first appointment and behind it I was terrified.

She won some points for acknowledging how traumatic the whole getting kicked out of school mess was.

I decided to keep meeting with her.

I never told her where I go to school or where I work. It started to feel silly after awhile, but it was a nice little extra level of safety. She couldn’t use that information to hurt me if she didn’t possess it.

She’s a psychologist, so she can’t prescribe. In the first week of August my Klonopin was going to expire. That date acted as a deadline for when I needed to transition therapy to a psychiatrist or at least find a psychopharmacologist.

Through a misunderstanding, she thought I wanted to end at the end of June. I’d been thinking more like the end of July, but decided to leave it at June.

I went to her looking for CBT and received supportive therapy, not CBT.
That’s not useless, but also not what I’d been looking for.
For all of ABCT’s posturing about empirically supported treatments and manualized therapies, I didn’t see much of that. I shouldn’t really be that surprised that outside of a research setting CBT can mean anything really. Both CBT and Psychodynamic ideas have problems with inconsistencies in their implementation. Finding that specific treatment you want out in the world is not so simple.

I was even willing to fill out worksheets. There was not a single one. I have trouble believing it’s real CBT without a worksheet or two.

She did admit that it wasn’t really CBT.

Maybe getting something other than CBT from a CBT practitioner was all I could really handle. If nothing else it was some exposure therapy to just show up.

I had such a problem during the spring semester in one of my classes. My intellectual feelings about CBT differ from my emotional feelings. Speaking in class I need to be so careful to only speak from my frontal cortex rather than from my amygdala. Too often I’ve allowed bit of emotion to bleed into my words.

Professionally I need to be able to separate the two. More and more I am encountering situations that push my limits with exposure to CBT outside of my own personal therapy.

Villainizing CBT can be too easy when working with psychodynamically oriented therapists. There is a long history of animosity between the two groups. They tend to collude with me in this issue. The difference is that they are objecting to it theoretically (although emotions are certainly there, but they are an effect rather than a cause), while I am objecting to it emotionally and finding intellectual reasons to rationalize that emotional reaction.

I do feel I got some benefit from the therapy, even though it was clear the therapist felt she’d failed me somehow. Most sessions were me spending an hour going through my massive to do list. I was so busy and exhausted that directing therapy towards a goal was way outside of my present abilities.

Just being there with a CBT therapist, the content wasn’t important. What was important was the conflict free relationship with a CBT practitioner. This helped me work through some of the negative transference I’d been experiencing toward her before the first appointment. Really in this way the “CBT” therapy did more for my object relations than a lot of psychodynamic therapy has done.

I’m still messed up, but this feels like a teensy step in a good direction.

I feel embarrassed about going to see a CBT therapist. I called S.M. a couple of times while I was seeing her. I lied saying I wasn’t in therapy. I asked him for a referral for the new therapist I went to see after this CBT therapist. I also did not tell the new therapist who I saw on Thursday. I lied and said I’d been out of therapy entirely for the past couple of months.